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Organization

JENNDA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER ANN HAWKINS MS, SUDP (CO-OWNER)
(208) 889-8594
Entity
Organization

Contact information

Practice address
4305 N ROYAL ST, COEUR D ALENE, ID 83815-9237
(208) 889-8594
Mailing address
PO BOX 19604, SPOKANE, WA 99219-0034
(208) 889-8594

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Enumeration date
07/01/2020
Last updated
07/01/2020
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